Key result
Trauma-related clinical practices varied considerably across 52 Dutch emergency departments, with thrombosis prophylaxis for below-knee casts used in 27% and vitamin C for wrist fractures in 50%.
Why the study?
Structural insights into the use of protocols and the extent of clinical practice variation across emergency departments were lacking.
What is the extent of practice variation in trauma-related clinical practices among Dutch Emergency Departments?
Cross-Sectional (n=52)
Yes
What is the extent of practice variation in trauma-related clinical practices among Dutch Emergency Departments?
There is considerable variation in trauma-related clinical practices among Dutch emergency departments, highlighting a potential area for quality and efficiency improvement through standardization.
Structural insights in the use of protocols and the extent of practice variation in EDs are lacking. The objective is to determine the extent of practice variation in EDs in The Netherlands, based on specified common practices. We performed a comparative study on Dutch EDs that employed emergency physicians to determine practice variation. Data on practices were collected via a questionnaire. Fifty-two EDs across The Netherlands were included. Thrombosis prophylaxis was prescribed for below-knee plaster immobilization in 27% of EDs. Vitamin C was prescribed in 50% of EDs after a wrist fracture. Splitting of applied casts to the upper or lower limb was performed in one-third of the EDs. Analysis of the cervical spine after trauma was performed by the NEXUS criteria (69%), the Canadian C-spine Rule (17%) or otherwise. The imaging modality for cervical spine trauma in adults was a CT scan (98%). The cast used for scaphoid fractures was divided between the short arm cast (46%) and the navicular cast (54%). Locoregional anaesthesia for femoral fractures was applied in 54% of the EDs. EDs in The Netherlands showed considerable practice variation in treatments among the subjects studied. Further research is warranted to gain a full understanding of the variation in practice in EDs and the potential to improve quality and efficiency.
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Tierie et al. (2023) conducted a cross-sectional in Trauma (n=52). Emergency department clinical practices was evaluated on Extent of practice variation based on specified common practices. Trauma-related clinical practices varied considerably across 52 Dutch emergency departments, with thrombosis prophylaxis for below-knee casts used in 27% and vitamin C for wrist fractures in 50%.
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